A few months ago, we watched the incredible feats of athletes who, through intense training and hard work, made it to the Olympics and brought home gold. They couldn’t have accomplished so much without the support of their teams and particularly their coaches.
Physicians work as hard as Olympic athletes, and while we might not aspire to a podium, we take pride in our best clinical abilities. Our judges are our patients and colleagues, and with their occasional feedback, we contentedly trudge on.
We keep up to date with our obligatory CME by attending conferences that are of interest to us, but perhaps unconsciously, we favor those conferences and courses that confirm that we are current in practice.
Occasionally we receive wake-up calls that make us stop and think: a colleague may stop us in the hall and ask, “Do you remember that patient…?” Nothing good ever follows those words. Equally disconcerting is the receipt of a buff-colored envelope from the College marked “private and confidential.” Or worse, a notification of a malpractice action. Few of us would regard those instances as learning opportunities. Concerns about competence strike at the very core of what we are trying to be: good doctors. A common response to criticism is to employ defence tactics: we tend to think things like “it couldn’t be me,” “it was a one-off,” or “things were really hectic that day.”
So, if we aren’t receiving constructive feedback, and if we let our CME drift in familiar waters, and if criticism is shunned, could we not then just rely on our own instincts? Unfortunately, self-evaluation is well known for its shortfalls: top performers tend to underrate themselves, bottom performers tend to overrate themselves. Even if we had some privileged insight into our deficiencies, it is questionable that we would be able to act on those deficiencies in a sustained matter.
Some time ago I decided that it was no longer appropriate to work as an emergency physician in one of BC’s busiest emergency departments without the CCFP(EM) credentials that so many of my younger colleagues had obtained. After 20 years of never having challenged any test more substantial than the ACLS or ATLS examinations, I decided that it was time to prepare for the CCFP(EM) examination. Fortunately, a close friend and colleague whom I very much respect offered to coach me.
For many late afternoons and evenings he questioned and grilled me. I soon discovered that although I had become quite comfortable and assured in my clinical abilities over the years, in many areas I had become unconsciously dyscompetent.[2,3] In other words, I did not know how much I did not know. However, this editorial is not about the unpleasant summer I spent studying in my basement to pass the CCFP(EM) exam but rather to share my revelation that no matter how prepared I thought I was in clinical practice in my formative years, I had not been able to sustain optimal clinical knowledge by my own direction. I was fortunate to have had a coach.
Next year the College will be instituting a multisource feedback assessment program starting with family physicians. Feedback data from patients, colleagues, and co-workers will help identify opportunities for improvement. It is likely, however, that few of us will make changes without the guidance of someone we respect: someone we are willing to listen to and take advice from. I have no doubt that being coached provides the ultimate professional development experience, and I encourage all of you to consider who your coach might be as you continue your own professional journey.
Give it some thought. I’m sure you’ll smile at the reactions of patients and colleagues when they ask you, “Who is that person following you around?” and you reply, “That’s my coach—I’m going for gold!”
1. Eva KW, Regehr G, Gruppen L. Blinded by “insight”: Self-assessment and its role in performance improvement. In: Hodges BD, Lingard L (eds). Blindspots: Health professional competence in the 21st century. New York: Cornell University Press. Chapter 10.
2. Hanna E, Premi J, Turnbull J. Results of remedial continuing medical education in dyscompetent physicians. Acad Med 2000;75:174-176.
3. Kruger J, Dunning D. Unskilled and unaware of it: How difficulties in recognizing one’s own incompetence lead to inflated self-assessments. J Pers Soc Psychol 1999;77:1121-1134.
4. Gawande A. Top athletes and singers have coaches. Should you? The New Yorker. 3 October 2011. Accessed 27 August 2012. www.newyorker.com/reporting/2011/10/03/111003fa_fact_gawande.